Aspergillosis: symptoms, causes, types and treatment

The NHS says aspergillosis is a condition caused by aspergillus mould. There are several types, and most affect the lungs. Asthma + Lung UK explains that it is caused by breathing in the small spores from aspergillus mould, which are usually harmless and easily removed by the immune system.

Aspergillus spores are very common. Asthma + Lung UK says they can be found in rotting leaves, crops and other plants and trees, and can also grow in damp housing, carpets, pillows and bedding.

The NHS lists shortness of breath, a cough that may bring up blood or lumps of mucus, wheezing, a high temperature, losing weight without trying and feeling tired. Asthma + Lung UK adds chest pain or discomfort and gives a fever of 38 degrees Celsius or more.

If you already have a lung condition, both sources say your symptoms may get worse. The NHS notes that it can be difficult to diagnose aspergillosis and it may take time.

• Shortness of breath and wheezing.

• A cough, which may bring up mucus or blood.

• Chest pain or discomfort.

• A high temperature.

• Weight loss without trying, and tiredness.

The NHS says treatment depends on the type you have and usually aims to help control the symptoms, and that if it is not treated or well controlled there is a risk it could damage your lungs. Asthma + Lung UK says antifungal medicines are the main treatment for all types, and that they need to be taken for weeks, months or sometimes even longer, and that the full course should be taken to help prevent antifungal resistance.

Steroid tablets, with or without antifungal medicines, may be prescribed for allergic bronchopulmonary aspergillosis (ABPA). Asthma + Lung UK says some people with ABPA or severe asthma with fungal sensitisation may be offered a biologic, a specialist injection given in hospital, and that surgery to remove an aspergilloma may be suggested if you are coughing up blood and medicines are not helping.

Asthma + Lung UK lists the main types of pulmonary aspergillosis as ABPA, severe asthma with fungal sensitisation (SAFS), chronic pulmonary aspergillosis (CPA) and aspergillomas, invasive pulmonary aspergillosis (IPA) and aspergillus bronchitis.

It says ABPA is an allergic reaction that mostly affects people with asthma and can also affect people with cystic fibrosis. CPA is a long-term infection, usually in people with damage to their lungs from a condition like COPD, bronchiectasis, sarcoidosis or cystic fibrosis, and an aspergilloma is a ball of mould that forms in damaged areas of the lungs. IPA is the most serious type and can be life-threatening, mainly affecting people with very weakened immune systems.

Aspergillus bronchitis is an infection in the large airways, and Asthma + Lung UK says treating it with antifungal medicines works well.

No. The NHS says you cannot catch aspergillosis from someone else or from animals, and Asthma + Lung UK says it is not contagious. Most people who breathe in the mould do not get ill because their immune system destroys the fungal spores.

Aspergillosis is usually caused by breathing in tiny bits of mould. The NHS says you are usually only at risk if you have a lung condition such as asthma, cystic fibrosis or COPD, a weakened immune system, for example after an organ transplant or during chemotherapy, have had tuberculosis (TB), or have had severe flu or COVID-19 and needed help breathing with artificial ventilation.

Asthma + Lung UK adds bronchiectasis, NTM infection, pneumonia needing intensive care, and taking long-term steroids and antibiotics to the list of risk factors.

The NHS says a GP will check that your symptoms are not being caused by something else, like a chest infection, and if they are not sure, may refer you to a specialist for tests such as X-rays and scans, blood tests or tests on a sample of mucus, allergy tests, or a bronchoscopy.

Asthma + Lung UK notes that allergy tests can show whether you are allergic or sensitive to aspergillus mould, but this does not always mean you have aspergillosis. It can sometimes take time to get a diagnosis because symptoms can be similar to other lung conditions and chest infections.

The NHS says to see a GP if you have a cough for more than 3 weeks, if you have a lung condition that is getting worse or harder to control with your usual treatment, or if you have a weakened immune system and symptoms of aspergillosis.

It says to ask for an urgent GP appointment or get help from NHS 111 if you cough up blood.

The NHS says it is almost impossible to completely avoid aspergillus mould, but people with a lung condition or weakened immune system can lower their chances. It suggests avoiding places where the mould is often found such as compost heaps and piles of dead leaves, opening windows several times a day, wearing a face mask in dusty places or when gardening, considering a dehumidifier and a HEPA air purifier, and keeping the house heated at between 18 and 21C in cold weather.

It also suggests not drying laundry in bedrooms or living areas where possible, and not opening windows if there is construction work or digging outside.

Aspergillosis is usually diagnosed and managed by respiratory specialists after a GP referral. The NHS points people to the Aspergillosis Patient and Carer Support organisation for information and support.

Private respiratory consultations can offer faster access to scans and tests, but treatment, particularly long-term antifungal therapy, needs specialist monitoring because of side effects and interactions with other medicines.